Economic changes are influencing the work patterns within the nursing profession in many ways. Nurses are opting to work extra shifts; others are coming out of retirement.

"Some nurses in our per diem pool used to work infrequently, maybe 1 day a pay period to keep their skills up or to maintain seniority within our organization," said Judy Zedreck-Gonzalez, MPM, BSN, RN, chief nursing officer and vice president of operations at Allegheny General Hospital, Pittsburgh. "When those nurses experienced a loss of hours from their other jobs, or when their significant others had layoffs or reduced hours, the nurses saw an opportunity to maintain their livelihood and support their families by staying at the bedside for more shifts. We've seen our part-time and full-time nurses pick up extra shifts as well, and we're monitoring that closely to ensure they're not taking on too much work."

Extra Shifts

Cheryl Fugatte, MSN, RN, chief nursing officer at Jewish Hospital & St. Mary's HealthCare (JHSMH), Louisville, KY, agreed with her colleague's perspective. "For years, nurses at JHSMH have picked up extra shifts, and they're used to the extra income. We're seeing nurses who are working extra to make up for family members who are losing their jobs, or who are having their hours cut," she said. "Our nurses also work extra for patient care reasons; if we have a call in, our nurses pick up for other team members when they can. But I'd say 90 percent of the time, the extra shifts are taken to benefit them financially."

Although the economic changes are putting a lot of stresses on nurses, there's also a silver lining. "Throughout the city of Louisville, chief nursing officers are seeing nurses from our hospital working PRN at their facilities, and we see nurses from those facilities coming here as well," said Fugatte. "A nurse may work 36 hours at our hospital, and then pick up some shifts at another hospital across town. These nurses have been through our orientation, we've determined that they have the skill set we need, and they have to work a certain number of hours to keep their per diem position. They bring new ideas to our hospital, so everyone benefits."

Economic changes have led to stability in nursing assignments that benefit patients. "Several years ago, there was a time when we had a number of vacancies and had to use traveling nurses," said Zedreck-Gonzalez. "Today, we're seeing a different picture within our health system, across Pittsburgh and throughout the region. There's not as much of a nursing shortage, and some nurses who used to be travelers applied for permanent positions in various hospitals."

As Allegheny General nurses sign up for additional hours at the bedside, everyone benefits. "When our nurses pick up extra shifts, that allows us to maintain our staffing ratios and keep our doors open to patients," said Zedreck-Gonzalez. "If a patient comes in and needs a bed, we can bring in a nurse from our casual pool who knows our systems, our communication channels, and our policies and procedures."

Retaining Seasoned Nurses

Well aware of the physical demands of bedside care, Fugatte is committed to finding ways to encourage seasoned nurses to return to the workplace. "I was at a Magnet conference, and many people were talking about those tenured nurses who retired before the economy changed," she said. "I think everyone is going to be asking, 'What can we do to bring these nurses back into the workforce, and how can we keep other experienced nurses in practice?'. Just last week, I pulled files on everyone who retired a year ago, looking for roles that might be of interest to them. They may not want to come back for 12-hour shifts, but they might be interested in a 4-hour breaking shift or a different role within our health system."

Those clinicians can play an important role in filling the gap left when other experienced nurses leave the bedside. "We have a number of nurses going into advanced practice nursing roles, especially in critical care and ED," Fugatte said. "It's beneficial for us to have these acute care nurse practitioners working side by side with our physician groups to care for our patients."

Deborah Hayes, MS, RN, NE-BC, vice president and chief nursing officer at The Christ Hospital, Cincinnati, is concerned about what will happen down the road. "I believe keeping seasoned nurses at the bedside has a positive effect on patients, but I worry we'll lose that advantage in a few years when things turn around," she said. "We'll have a large number of novice nurses who need mentoring, and we'll lose that wisdom gained by years of nursing practice. We're trying to keep seasoned nurses within our organization without subjecting them to the physicality of bedside nursing. For example, we've opened an eICU where experienced critical care nurses can monitor in a comfortable environment, we've increased the number of experienced nurses in our quality department, and we've put seasoned nurses in place as unit-based educators to keep that nursing wisdom on the nursing units."

Hayes is currently enjoying a zero-percent vacancy rate on her nursing units and overtime hours are the lowest in a long time. "As the nursing shortage improves in an area, and nursing vacancies decline within a particular institution, this is what usually happens," she said. "But I think this is a very short-lived situation because some nurses came back into the profession temporarily and others didn't leave when they originally planned to. When the economy improves and those nurses do leave, it's going to hit fast and hard."

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